AGPCARE-0075-19 Diabetes Mellitus (E08-E13) ICD-10-CM Coverage provided by Amerigroup Inc. This publication contains proprietary information. This material is for informational purposes only. Reference the Centers for Medicare and Medicaid Services (CMS) for more information on Risk Adjustment and the CMS-HCC Model. Redistribution or other use is strictly forbidden This publication is for informational purposes only and is not guaranteed to be without defect. Please reference the current version(s) of the ICD-10-CM codebook, CMS-HCC Risk Adjustment Model, and AHA Coding Clinic for complete code sets and official coding guidance. 62682MUPENABS 09/15/16
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AGPCARE-0075-19
Diabetes Mellitus (E08-E13) ICD-10-CM
Coverage provided by Amerigroup Inc. This publication contains proprietary information. This material is for informational purposes only. Reference the Centers for Medicare and Medicaid Services (CMS) for more information on Risk Adjustment and the CMS-HCC Model. Redistribution or other use is strictly forbidden
This publication is for informational purposes only and is not guaranteed to be without defect. Please reference the current version(s) of the ICD-10-CM codebook, CMS-HCC Risk Adjustment Model, and AHA Coding Clinic for complete code sets and official coding guidance.
62682MUPENABS 09/15/16
Diabetes mellitus and ICD-10-CMOne of the major changes from ICD-9-CM to ICD-10-CM is the coding for diabetes mellitus (DM). This is due to the creation of combination codes that are greatly used in coding for diabetic conditions.
In ICD-10-CM, the combination code includes the type of DM, body system affected and the specific complication involving that body system. The creation of these expanded combination codes permit for multiple conditions to be reported with fewer codes.
ICD-10-CM: Type II DM with diabetic CKD (E11.22), ESRD (N18.6) and dialysis status (Z99.2)
5. Other specified DM (E13): includes DM due to genetic defects, post-pancreatectomy, post-procedural and secondary DM (not elsewhere classified)
Note: Codes from categories E10-E13 DM are sequenced first, followed by codes for any additional complications outside of these categories, if applicable.
Some ICD-10-CM characteristics � Diabetes codes begin with an E (for endocrine). Alpha characters are not case-sensitive.
� Diabetes codes in ICD-10-CM can have up to seven characters. The first three characters represent the category. The fourth character identifies the presence of manifestations or complications. The fifth and sixth characters identify specific types of manifestation. The seventh indicates laterality when applicable.
� If the type is unclear or not documented, type DM 2 (category E11) would be used as default.
� For categories E08-E09 and E11-E13, include instructional notes to use an additional code to identify control such as insulin (Z79.4) or oral anti-diabetic/hypoglycemic drugs (Z79.84).
� Long-term current use of insulin (Z79.4) identifies the use of insulin for diabetic management routinely used. Code Z79.4 should not be assigned if insulin is given temporarily to bring a type 2 diabetic patient’s blood sugar under control during an encounter. Additionally, assigning Z79.4 with category E10 codes is unnecessary. For patients with type 1 diabetes, the use of insulin is required; therefore, reporting Z79.4 is redundant.
� New diabetic complications include diabetes w/skin complications, oral complications and arthropathy. Ophthalmic conditions are expanded as well.
� In ICD-10-CM, the classification assumes a causal relationship between diabetes and certain diseases of the kidneys, nerves and circulatory system. Although documentation is not required to link diabetes and certain conditions, it is always recommended to document to the highest degree of specificity. This includes identifying any causal relationship between two conditions, when appropriate, with linking verbiage such as “due to...”
� If the type of diabetes is not identified when diabetic ketoacidosis is documented, query the provider for the type.
Instead of classifying DM as controlled or uncontrolled, ICD-10-CM classifies inadequately controlled, out of control and poorly controlled
as DM (by type) with hyperglycemia.
There are 5 categories for DM, broken down by type:1. DM due to underlying condition (E08):
Code first the underlying condition. � Example: DM, due to Cushing’s syndrome, with
diabetic nephropathy. ICD-10-CM: Cushing syndrome (E24.9) and DM due to underlying condition with diabetic nephropathy (E08.21)
2. Drug or chemical induced DM (E09): Code first poisoning if due to drug or toxin from category T36-T65 with fifth or sixth character 1-4 or 6. Use an additional code to identify if diabetes is an adverse effect of a drug from category T36-T50 with fifth or sixth character 5. Reference the table of drugs and chemicals in the ICD-10-CM index.
� Example: The physician documents active treatment for a patient with corticosteroid-induced DM, without complications. ICD-10-CM: drug or chemical induced DM w/out complications (E09.9) and adverse effect of glucocorticoids and synthetic analogues, initial encounter (T38.0X5A)
3. Type I DM (E10): � Example: A patient with type 1 diabetes has
developed moderate nonproliferative diabetic retinopathy of the left eye. ICD-10-CM: Type 1 DM with moderate nonproliferative diabetic retinopathy without macular edema, left eye (E10.3392)
4. Type 2 DM (E11): � Example: Patient with diabetes and ESRD on
dialysis.
� ICD-10-CM provides coders with a much greater range of DM codes to choose from in categories E08-E13. As a result, providers must document additional detail to describe complications resulting from diabetes.
Comparison A 50 years old female with DM I and HTN
was recently diagnosed with diabetic nephropathy.
ICD–9-CM ICD–10-CM250.41: DMI with renal manifestations, not stated as uncontrolled
583.81: nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere
Code first poisoning due to drug or toxin or use an additional code for adverse effect to identify drug (when applicable).
E09
Other specified DM E13
ICD-10-CM coding examples for diabetesPatient has severe non-proliferative diabetic retinopathy with macular edema of both eyes due to insulin-dependent type 2 DM.ICD-10-CM: type 2 DM with severe non-proliferative diabetic retinopathy with macular edema, bilateral (E11.3413) and long-term use of insulin (Z79.4)
Rationale: Combination DM code. No other code is needed.
Patient has type 1 DM with moderate non-proliferative diabetic retinopathy with macular edema.ICD-10-CM: E10.3319
Rationale: Code includes the type of DM, body system involved and complications of the body system (including the specific eye involved). No additional code is necessary.
Patient has type 2 DM with diabetes-related CKD stage 3.ICD-10-CM: type 2 DM with diabetic CKD (E11.22) and CKD, stage 3 (N18.3)
Rationale: A note under the code for type 2 DM with diabetic CKD instructs to use an additional code to identify the stage of CKD (N18.1–N18.6).
A type 2 DM patient is evaluated for a chronic diabetic right foot ulcer with necrosis of muscle; patient takes insulin daily.ICD-10-CM: type 2 DM with foot ulcer (E11.621), non-pressure chronic ulcer of other part of right foot with necrosis of muscle (L97.513) and longterm use of insulin (Z79.4)
Rationale: Code E11.621 states to use an additional code to identify site of ulcer (L97.4-L97.5-)
Diabetes due to idiopathic acute pancreatitis; diabetic hyperglycemia started on insulin to control blood sugar.ICD-10-CM: Code first underlying condition, idiopathic acute pancreatitis (K85.0). Code DM due to underlying condition with hyperglycemia (E08.65) as secondary.
Rationale: Long-term (current) use of insulin (Z79.4) should not be coded if insulin is given temporarily to bring the patient’s blood sugar under control during an encounter.
Patient with type 2 DM is diagnosed with retinopathy, including bilateral macular edema. Patient’s diabetes is not controlled.ICD-10-CM: type 2 diabetic retinopathy with macular edema (E11.311) and diabetes with hyperglycemia (E11.65)
ReferencesKostick, Karen M. “Coding Diabetes Mellitus in ICD-10-CM: Improved Coding for Diabetes Mellitus Complements Present Medical Science”. Journal of AHIMA 83, no. 5 (May 2012); pages 56-58
Becks, Lori. “Coding Diabetes Mellitus in ICD-10-CM” Code it Right Insights (March 03, 2011): www.codeitrightonline.com
Health Information Management, “ICD-9-CM vs. ICD-10-CM: Examine the Differences in Diabetes Coding” JustCoding News (July 25, 2012): hcpro.com